Etomidate is preferred over propofol for induction in a patient with suspected adrenal insufficiency because:

• A Etomidate preserves cardiovascular stability but inhibits 11-beta-hydroxylase, worsening cortisol deficiency ✓
• B Etomidate stimulates ACTH release, compensating for adrenal insufficiency
• C Etomidate has no effect on adrenal steroidogenesis and provides better haemodynamic stability
• D Propofol inhibits aldosterone synthesis, making hypotension more severe

Explanation

This question highlights a key disadvantage: etomidate inhibits 11-beta-hydroxylase (and other steroidogenic enzymes) in the adrenal cortex, reducing cortisol synthesis for up to 24 hours even after a single induction dose. This makes it potentially harmful rather than beneficial in patients with suspected adrenal insufficiency. Etomidate's cardiovascular stability is an advantage in critically ill or haemodynamically unstable patients who do not have adrenal compromise. In patients with known or suspected adrenal insufficiency, ketamine or careful low-dose propofol with vasopressor support is preferred, and stress-dose steroids should be provided.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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